((If trainees do not apply high-flow oxygen via NRB within 2 minutes: Amelia's SpO2 drops to 90% on RA and her work of breathing increases. She begins to show subcostal recession and her voice becomes more strained. Prompt: 'Amelia is looking more tired and her breathing seems harder.'))

((If singed nasal hairs and hoarse voice are not identified or reported: Amelia spontaneously says in a hoarse voice 'my throat feels funny' at 5 minutes. Prompt facilitator to ask trainees: 'What does hoarseness and singed nasal hairs tell you about this patient's airway?'))

((If trainees do not begin cooling the burns within 3 minutes of assessment: Mother asks 'Should we be putting water on it?' Amelia's pain score remains 9/10 and she becomes increasingly distressed and less cooperative.))

((If trainees fail to note the reduced sensation over the anterior chest full-thickness area and do not document it: Facilitator prompts at 8 minutes — 'Amelia says the chest doesn't hurt much — is that reassuring or concerning? Why?'))

((If trainees attempt to apply creams, butter, or non-sterile materials to burns: Facilitator stops scenario briefly to correct — 'What does the Burn Trauma CPG say about wound dressing?' Only cool water and damp sterile dressings are appropriate.))

((If trainees do not continuously reassess the airway for progressive oedema: At 12 minutes introduce mild audible stridor — 'Amelia's breathing sounds different now. What do you notice?' This simulates onset of airway oedema and should trigger urgent Priority 1 pre-notification and consideration of backup.))

((If Methoxyflurane (Penthrox) is considered for analgesia: Facilitator confirms — 'Amelia is 8 years old, 25 kg, alert and cooperative. Is Penthrox appropriate here? Can she self-administer?' Per CPG, Penthrox is authorised for paediatric patients >1 year. Trainees must confirm she can understand and cooperate with the device.))

This patient is suffering from paediatric mixed partial-thickness and full-thickness burn trauma to approximately 9–10% TBSA with a suspected inhalation injury based on singed nasal hairs, eyebrow singeing, hoarse voice, and tachypnoea.

• Ensure scene safety — confirm gas burner has been shut off and scene is safe before approaching.
• Perform Primary Survey with c-spine consideration — mechanism does not suggest spinal injury, no c-spine precautions required.
• Identify suspected inhalation injury immediately — singed nasal hairs, singed eyebrows, hoarse voice, tachypnoea, and SpO2 93% on RA are RED FLAGS for evolving airway compromise.
• Apply oxygen via non-rebreather mask (NRB) at 10–15 L/min — target SpO2 ≥95% for paediatric patient. Note: carbon monoxide inhalation may cause falsely normal SpO2 readings; treat clinically.
• Begin burn cooling immediately — cool burn areas with running water at approximately 15°C for a minimum of 20 minutes. Do NOT use ice, ice water, or butter.
• Perform burn area assessment using Rule of 9's — right forearm approximately 4.5% TBSA (partial-thickness), anterior chest approximately 5% TBSA (full-thickness). Total estimated 9–10% TBSA.
• Document time of burn injury — fluid calculations (if performed by Advanced Care) are calculated from time of burn, not EHS arrival.
• Remove jewellery and clothing unless adhered to wound — check right forearm for any bracelets or tight clothing. Do NOT remove adhered material.
• Assess depth of burns — right forearm: red, blistered, wet, extremely painful = partial-thickness. Anterior chest: pale, waxy, dry, leathery, reduced sensation = full-thickness. Document both.
• Identify and document reduced sensation over anterior chest — reduced pain over full-thickness burns is expected and should not be mistaken for the patient being less seriously injured in that area.
• Administer Methoxyflurane (Penthrox) 3 mL via inhaler for analgesia — Amelia is 8 years old, 25 kg, alert, oriented, and able to cooperate. Paediatric dose: 3 mL inhaled intermittently. Confirm patient understanding of device. Monitor for over-sedation.
• Apply damp sterile dressings to burn areas after minimum 20 minutes of cooling — do not apply dry dressings directly to burns. Do not apply creams, gels, or non-sterile materials.
• Perform Vital Sign Survey — GCS, SpO2, RR, HR, BP, BGL, temperature, pain score, PERL.
• Continuously monitor airway — reassess for stridor, increasing hoarseness, increased work of breathing, or drooling every 2–3 minutes. These indicate progressive airway oedema and are a time-critical emergency.
• Perform Secondary / CNS Survey — assess for other injuries from the flash flame (eyes, other body surface areas).
• Administer Ondansetron 4 mg oral wafer for nausea and vomiting prophylaxis (spinal/eye injuries indication is not applicable here; if patient vomits or has moderate to severe nausea this is an authorised indication) — Amelia is >4 years and >15 kg. Do not repeat paediatric dose.
• Record full observations every 10 minutes — or every 5 minutes given time-critical presentation.
• Pre-notify receiving facility (Perth Children's Hospital — paediatric burns tertiary centre, patients 15 years and under) — patient has >5% TBSA paediatric burns, airway burns suspected, Priority 1 transport indicated.
• Keep patient warm — avoid hypothermia during cooling. Cover cooled areas with damp sterile dressings and cover remainder of patient with a blanket after cooling phase.
• Reassure Amelia and her mother continuously throughout the scenario — child is distressed, keep communication calm, age-appropriate, and include the parent.
• Scenario ends on arrival of ambulance and IMISTAMBO handover.
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Burn Trauma · Dyspnoea & Respiratory Distress · Oxygen Delivery · Methoxyflurane (Penthrox) · Ondansetron · Primary Survey · Secondary & CNS Survey · Bag Valve Mask Ventilation · Pain Assessment · Penthrox Inhaler Administration · Minor Wound Management